早期急性胰腺炎严重程度的影响因素及其预测价值

Influencing factors and predictive value of severity of early acute pancreatitis

目的探索急性胰腺炎早期严重程度的影响因素及预测价值。方法选取2021年6月至2022年12月于毕节市第一人民医院收治的270例急性胰腺炎患者为研究对象,按疾病严重程度分级分为轻度急性胰腺炎(MAP)(129例)、中重度急性胰腺炎(MSAP)(100例)和重度急性胰腺炎(SAP)(41例)三组,进行各组间临床资料和实验室指标比较,筛选出有统计学差异的指标,作为自变量,进行多因素logistic回归分析,分析急性胰腺炎严重程度的独立危险因素,并通过ROC曲线评估预测效能。结果临床资料中,三组患者的年龄、性别和病因比较,差异无统计学意义(P>0.05),MAP组、MSAP组和SAP组患者的住院天数中位数分别为8、8、12d,急性生理学及慢性健康状况评分系统(APACHEⅡ)评分中位数分别为3、6、14分,三组间的住院天数和APACHEⅡ评分比较,差异有统计学意义(P<0.05)。实验室指标中,三组间的钙(Ca)、纤维蛋白原(FIB)、纤维蛋白原/白蛋白比值(FAR)和Treg细胞百分比比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,Treg细胞百分比和APACHEⅡ评分是急性胰腺炎严重程度的独立危险因素(P<0.05)。ROC曲线分析结果显示,Treg细胞百分比和APACHEⅡ评分联合预测的下面积为0.912、灵敏度为85.4%、特异度为81.1%。结论外周血CD4^(+)CD25^(+)FOXP3^(+)Treg细胞联合APACHEⅡ评分能够明显提高急性胰腺炎早期严重程度的预测价值。

Objective To explore the influence factors and predictive value of early severity of acute pancreatitis.Methods A total of 270 patients with acute pancreatitis admitted to the First People's Hospital of Bijie City from June 2021 to Decem-ber 2022 were selected as the study subjects,and were divided into three groups according to disease severity:mild acute pancreatitis(MAP)(129 cases),moderate and severe acute pancreatitis(MSAP)(100 cases)and severe acute pancreatitis(SAP)(41 cases).Clinical data and laboratory indicators were compared among the groups,and indicators with statistical differences were selected as independent variables.Multivariate logistic regression analysis was performed to analyze independent risk factors for the severity of acute pancreatitis,and the predictive efficacy was evaluated by ROC curve.Results In clinical data,there was no significant difference in age,gender and etiology among the three groups(P>0.05).The median length of hospital stay in MAP group,MSAP group and SAP group were 8,8 and 12 days,respectively,and the me-dian scores of acute physiology and chronic health status scoring system(APACHEⅡ)were 3,6 and 14 points,respectively.There were statistically significant differences in length of hospital stay and APACHEⅡscore among the three groups(P<0.05).In laboratory indicators,there were significant differences in calcium(Ca),fibrinogen(FIB),fibrinogen/albumin ratio(FAR)and percentage of Treg cells among the three groups(P<0.05).Multivariate logistic regression analysis showed that Treg cell percentage and APACHEⅡscore were independent risk factors for the severity of acute pancreatitis(P<0.05).ROC curve analysis showed that the combined prediction of Treg cell percentage and APACHEⅡscore was 0.912,sensitiv-ity was 85.4%,and specificity was 81.1%.Conclusion CD4^(+)CD25^(+)FOXP3^(+)Treg cells combined with APACHEⅡscore in peripheral blood can significantly improve the predictive value of early severity of acute pancreatitis.